Provider Demographics
NPI:1134209083
Name:FOOTE, NANCY RYAN (ARNP)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:RYAN
Last Name:FOOTE
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:BOX 116
Mailing Address - Street 2:
Mailing Address - City:HARTLAND
Mailing Address - State:VT
Mailing Address - Zip Code:05048
Mailing Address - Country:US
Mailing Address - Phone:802-436-2605
Mailing Address - Fax:
Practice Address - Street 1:331 UPPER PLAIN SUITE 1
Practice Address - Street 2:UPPER PLAIN
Practice Address - City:BRADFORD
Practice Address - State:VT
Practice Address - Zip Code:05033
Practice Address - Country:US
Practice Address - Phone:802-222-4722
Practice Address - Fax:802-222-4709
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2011-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT101001449363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30005705Medicaid
VT1007934Medicaid
VT1007934Medicaid